(D) overall TerkawriaAnSg, Meavridis D, Seosnsler DI,
et al. Pain Management Modalities
after Tmotaol KtnioeenArthirnoplatshty.eA first 72 h. Network Meta-analysis of 170
内界：小骨 盆 的界线
向下一直延 续 到股骨小转 子 水平
覆盖腰大肌 和 髂肌
髂筋膜
闭孔神经与髂肌和髂筋膜并没有密切的联系
闭 孔 神 经
股神经、髂筋膜、隐神经
髂筋膜阻滞的扩散范围（MRI）
腹股沟韧带水平髂筋膜阻滞
腹股沟韧带水平
骶骨水平
冠状位
Swenson JD, Davis JJ, et al. Local anesthetic injection deep to the fascia iliaca at the level of the inguinal ligament: the pattern of distribution and effects on the obturator nerve. Jour股na神l o经f C、li髂nic筋al膜A、ne隐sth神e经sia (2015) 27, 652–657
朝阳医院超声麻醉疼痛周
髂筋膜、股神经和
隐神经/收肌管阻滞
朝阳医院麻醉科 蒋嘉
股神经、髂筋膜、隐神经
膝关节置换镇痛
Terkawi AS, Mavridis D, Sessler DI, et al. Pain Management Modalities after Total Knee Arthroplasty. A Network Metaanalysis of 170 Randomized Controlled Trials. 股An神es经th、es髂io筋log膜y 、20隐17神; 1经26:923-37
Terkawi AS, Mavridis D, Sessler DI, et al. Pain Management Modalities after Total Knee Arthroplasty. A Network Meta- analysis of 170 Randomized Contr股oll神ed经Tr、ia髂ls.筋An膜e、sth隐es神io经logy 2017; 126:923-37
膝关节置换镇痛
Primary outcomes: (1) acute postoperative pain (during rest and movement) (2) postoperative opioid consumption (3) quality of early postoperative rehabilitation (functional assessments)
of 170 Randomized Controlled Trials. Anesthesiology 2017; 126:923-37
股外侧皮神经 闭孔神经 股神经 隐神经
股神经、髂筋膜、隐神经
髂筋膜阻滞•阻滞的是Βιβλιοθήκη 么？股神经、髂筋膜、隐神经
髂筋膜
股神经、髂筋膜、隐神经
外界：髂嵴 内 侧缘
Secondary outcomes: postoperative complications (e.g., nausea, vomiting, falls), duration of hospitalization, blood loss, procedure failure, and patient withdrawal
超声引导腹股沟韧带上髂筋膜阻滞
• 寻找髂前上棘、髂肌、腹横肌 • 药液扩散：腹横肌和髂肌之间 • 阻滞：股神经、股外侧皮神经、髂腹股沟神经
Bullock WM, Yalamuri SM, Gregory SH, et al. Ultrasound-Guided Suprainguinal Fascia Iliaca Technique Provides Benefit as an Analgesic Adjunct for Patients Undergo股ing神T经ota、l 髂Hip筋A膜rt、hro隐p神la.经J Ultrasound Med 2017; 36:433–438
Randomized Controlled Trials. Anesthesiology 2017; 126:923-37
Ranking F/S (6) F/O(6) LP/S (3) FIC (3) PA (2)
Ranking on highquality studies F/S FIC LP PA ACB Terkawi AS, Mavridis D, Sessler DI, et al. Pain Ma股na神ge经m、en髂t M筋o膜da、lit隐ies神a经fter Total Knee Arthroplasty. A Network Meta-analysis
超声引导髂筋膜阻滞的方法
• 腹股沟韧带下法 • 寻找缝匠肌和髂肌 • 药液扩散：缝匠肌和髂肌之间 • 阻滞：股神经、股外侧皮神经？
股神经、髂筋膜、隐神经
超声引导髂筋膜阻滞
腹股沟韧带上法
Bullock WM, Yalamuri SM, Gregory SH, et al. Ultrasound-GuidedSuprainguinal Fascia Iliaca Technique ProvidesBenefit as an Analgesic Adjunct forPatients Undergoing 股To神tal经H、ip髂Ar筋thr膜op、la隐. J神U经ltrasound Med 2017; 36:433–438
与PCA比 较
股神经、髂筋膜、隐神经
(A) Overall pain scores in the first 72 h duringrest
(B) overall pain scores in the first 72 h during movement,
(C) overall opioid consumption in the first 72 h